Viral Hepatitis

Question 1

what is viral hepatitis?

Answer 1

Inflammation of the liver due to a virus

Question 2

what is the inflammatory mechanism of viral hepatitis?

Answer 2

infects cells in liver causing them to express MHC1 molecules, recognised by CD8+ cells and initiate cytotoxic killing and apoptosis?

Question 3

what are the general symptoms of viral hepatitis?

Answer 3

• Fever, malaise, nausea
• Hepatomegaly
• Pain
• ↑ blood transaminase
• ↑ atypical lymphocytosis
• Jaundice

Question 4

what is the definition of acute viral hepatitis?

Answer 4

<6 months

Question 5

what is the definition of chronic viral hepatitis?

Answer 5

> 6 months

Question 6

what are the types of viral hepatitis?

Answer 6

A,B,C,D,E

Question 7

what is the structure of hepatitis A?

Answer 7

Picornvirus – not enveloped, contains single stranded RNA in protein shell (Epstein barr?)

Question 8

what is the route of spread of hepatitis A?

Answer 8

faecal oral route

Question 9

what is the incubation period of hepatitis A?

Answer 9

2-4 weeks

Question 10

what are the clinical features of hepatitis A

Answer 10

o Always acute (no carrier state)
o Common in travellers
o Flu like symptoms
o Jaundice or hepatosplenomegaly

Question 11

what is the diagnostic serology of hepatitis A?

Answer 11

 HAV IgM = Active

 HAV IgG = recovery or vaccination

Question 12

what is the management of hepatitis A?

Answer 12

Supportive

Treatment

Question 13

What is the structure of hepatitis E?

Answer 13

single stranded, non enveloped RNA, cosahedral virus (hepevirus, cytomegaly virus)

Question 14

how is hepatitis E spread?

Answer 14

faecal oral

Question 15

what is the incubation period of hepatitis E?

Answer 15

o Always acute

o Similar to Hep A but greater mortality risk in pregnancy

Question 16

what is the diagnostic serology of hepatitis E?

Answer 16

o HEV IgM = Active

o HEV IgG = recovery

Question 17

what is the management of hepatitis E?

Answer 17

Supportive

No vaccine

Question 18

what is the structure of hepatitis C?

Answer 18

RNA flavivirus

Question 19

how is hepatitis C spread?

Answer 19

Blood spread – childbirth, sex, IV drug users

Question 20

what is the intubation period of hepatitis C?

Answer 20

6-9 weeks

Question 21

what are the two clinical presentations of hep C?

Answer 21

acute and chronic

Question 22

what are the clinical features of acute hepatitis C?

Answer 22

 Systemic – fatigue, nausea, joint pain, anorexia
 ↑ serum aminotransferase
 Jaundice

Question 23

what are the clinical features of chronic hepatitis C?

Answer 23

 Rheumatological problems – athralgia, arthritis
 Eye problems – sjogrens
 Cirrhosis
 Hepatocellular cancer
 Cryoglobulinaemia: typically type II
 Porphyria cutanea tarda
 Membranoproliferative glomerulonephritis

Question 24

what is the gold standard diagnostic test for hepatitis C?

Answer 24

HCV RNA (with PCR)
•	Levels decrease = recovery

Question 25

what are the diagnostic tests for hepatitis C?

Answer 25

Enzyme immunoassay – HCV IgG (doesn’t indicate active or protective disease) Recombinant immunoblot - ↑↓  HCV RNA (with PCR)

Question 26

what is the management of acute hepatitis C?

Answer 26

supportive

Question 27

what is the management of chronic hepatitis C?

Answer 27

• Combination of protease inhibitors o Daclatasvir + sofobuvir o Sofosbuvir + simeprevir • Interferon based treatments no longer recommended • Liver transplant – virus recurs afterwards

Question 28

what is the structure of hepatitis B?

Answer 28

hepadnaviral o Double stranded DNA o Outer lipid envelope and an icosahedral nucleocapsid core

Question 29

what is the other name for hepatitis B?

Answer 29

yellow fevelr

Question 30

how is hepatitis B spread?

Answer 30

``` o Blood (body fluid?) spread – sex, vertically (more likely to be chronic) Carriers exist ```

Question 31

what is the intubation period of hepatitis B?

Answer 31

6-20 weeks

Question 32

what are the serology features used in testing of hepatitis B?

Answer 32

o PCR can be used to look for makers o HBV surface antigen – lives on surface = HBsAg o Core antigen – lives in core of virus = HBcAg o E Antigen – biproduct of replication = HBc = marker of active infection

Question 33

what are the clinical features of hepatitis B?

Answer 33

o Systemic – fever | o Jaundice

Question 34

what are the complications of hepatitis B?

Answer 34

``` o Chronic hepatitis o Fulminant liver failure o Hepatocellular carcinoma o Glomerulonephritis o Polyarteritis nodosa o Cryoglobulinaemia ```

Question 35

what are the infective stages of hepatitis B?

Answer 35

active, initial immune response windows phase, acute end or chronic state

Question 36

what is the serology of the active phase of hepatitis B?

Answer 36

HBsAg is present and showing posistive – viral DNA + E antigen also o Antibodies are produced from IgM against HBcAg

Question 37

what are the serological features of the windows phase of hepatitis B?

Answer 37

neither surface antigen or IgG are detected as levels are so low – can detect core IgM antibodies

Question 38

what is the serology in successful end of hepatitis B infection?

Answer 38

IgM

Question 39

what are the serology features if an immune response is unsuccessful in hepatitis B?

Answer 39

 Surface antugens detected, no IgG |  Also presence of HBV DNA and antigen presence

Question 40

what is the serology in healthy chronic state hepatitis B?

Answer 40

presence of surface antigen and core antibody but no E antigen

Question 41

what is the serology of infective chronic state hepatitis B?

Answer 41

HBsAg, JBcAg, e antigen (all present)

Question 42

what are the prevention methods for hepatitis B?

Answer 42

minimse exposure: safe blood, safe sex, needle exchange, prevention of needlesticks, screening of pregnant women Vaccination

Question 43

what is the management of hepatitis B?

Answer 43

o Pegylated interferon – alpha used o Other anti-virals – tenofovir and entecavir o Post exposure prophylaxis - vaccine, plus HBIG

Question 44

what is the virology of hepatitis D?

Answer 44

single stranded RNA virus

Question 45

what needs to be present for hepatitis D infection?

Answer 45

o Requires Hep B surface antigen to complete replication and transmission cycle Co infection or super infection

Question 46

what are the clinical features of hepatitis D?

Answer 46

o Link with superinfection | o High risk of fulminant hepatitis (pregnancy), chronic hepatitis, cirrhosis

Question 47

what is the diagnostic test for hepatitis D?

Answer 47

reverse PCR reaction of hepatitis D RNA

Question 48

what is the management of hepatitis D?

Answer 48

interferon